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The University of Southampton
Clinical Ethics and Law at Southampton

Dr Lisa Ballard presented at COMET conference 2020

Published: 1 July 2020

Three possible futures: patient decision making regarding predictive genetic testing in the clinical genetics setting where there is little or no current utility

Most genetic tests are carried out to confirm a diagnosis. Some people are offered genetic tests for reasons that are only partly medical and where the patient’s personal views and preferences are as important (if not more important), than any medical reasons. The purpose of this research is to understand how patients make these decisions.


• Ambivalence is defined as having two opposing feelings at the same time.

• The patient in the genetics clinic may have felt ambivalent towards having a predictive genetic test for some time, and may also still be feeling this way.

• Ambivalence is often psychologically unpleasant (Reich & Wheeler, 2016), leading to a desire to resolve this ambivalence by making a decision or taking action.

• When helping a patient resolve ambivalence regarding changes in behaviour, a technique called two possible futures is used. This is likened to ‘a hypothetical look over the fence’ (Mason, 2019).

• Aim: to explore how imagining possible futures is used with patients deliberating the decision to have predictive genetic testing where there is little or deferred clinical utility.

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